Abstract Background and Aims Kidney transplantation is the module of choice to reduce mortality in comparison with dialysis [1]. Many patients on transplant waiting list undergoing haemodialysis via central venous catheters [2]. Cardiovascular morbidity control is one of the pillars of successful transplantation outcome [3]. Tans-thoracic echocardiographic abnormalities can be used to identify renal transplant recipients at high risk of cardiovascular disease [4]. Trans-oesophageal echocardiography is superior to trans-thoracic echocardiography in detecting vegetations. Endocarditis complicating central venous catheters often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires Trans-oesophageal echocardiography for diagnosis [5]. Three-dimensional trans-oesophageal echocardiography is considered the missed module for clear vegetations visualization [6]. Method Evaluation of Transoesophageal echocardiography results in 377 haemodialysis patients with central venous dialysis access planned for kidney transplantation. All patients were examined by transthoracic echocardiography and stated absent vegetations from our registry. Candidates were re-evaluated by real time trans-oesophageal procedure to diagnose possibility of silent vegetations. Informed consent was obtained. Results Among 377 patients undergoing haemodialysis via central venous access and recorded in transplantation waiting list. All of them were having absent vegetations stated by transthoracic echocardiography. Our patients were subjected to transoesophageal echocardiography. Results showed 13 patients with variable sized right sided 4-6 mm vegetations (3.4%). Among our positive group of patients six patients were founded with 6 mm vegetation (1.6%), four patients with 5 mm (0.5%) and finally three patients with 4 mm vegetations (0.7%). Conclusion Trans-oesophageal echocardiography may be implemented in renal transplant recipient basic preparation checklist for evaluation of silent vegetations associated with central access of dialysis.